Gaps in Care After Discharge Common for Adults

One in 3 adult patients aged 21 and older who are discharged from a hospital to the community does not see a physician within 30 days of discharge, according to a new national study by the Center for Studying Health System Change (HSC). Even 90 days after discharge, 17.6% still had not seen a physician, nurse practitioner, or physician assistant.

Many adults who do not see a physician after discharge are at high risk of readmission because of chronic conditions or physical activity limitations, according to the study, which used 2000-2008 data from the nationally representative Medical Expenditure Panel Survey to estimate the prevalence of hospital readmissions for all causes—other than obstetrical care—for adults aged 21 and older.

About 1 in 12 adults (8.2%) aged 21 and older discharged from a hospital to the community was readmitted within 30 days, according to the study, and 1 in 3 adults (32.9%) was rehospitalized within 1 year of discharge.

Thirty-day readmission rates are much higher for people who are sicker.

Among adults aged 21 to 64, readmission rates were highest for people with public coverage, mainly Medicare or Medicaid.

The vast majority of people admitted to a hospital reported having a usual source of care (90%). Only about a third of people with a usual source of care reported that after-hours care was available, and about one-fifth said it was difficult to contact their usual source of care by phone about a health problem. One in 10 reported difficulty getting to their usual source of care, which may reflect long travel times or lack of transportation.

On an annual basis, expenditures were $16.3 billion for hospital readmissions up to 30 days after discharge. While much of the policy focus has been on changing payment incentives in Medicare to decrease readmissions, private insurance pays for a greater share of 30-day readmissions (about 47%) than does Medicare (about 40%).

Comments

Part of the problem is discharge teaching is not taking place and patients continue to take their meds incorrectly. Some do not even bother to get their new Rxs filled or can afford their meds. Critical education is not taking place.